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March 26, 2018

Compliance and Addressing the Current Opioid Crisis

Written by: Compliance blogger


Some Current Statistics About the Opioid Crisis

Despite nationwide efforts, the CDC Vital Signs Report has noted that the number of opioid overdoses nationwide is continuing to rise. For example, the Midwest saw opioid overdoses increase by 70% in the 14 months between July 2016 and September 2017. In sixteen states, the number of opioid overdoses increased by 54%. The CDC has also noted that while opioid prescriptions have declined in recent years, prescribing rates still remain very high overall, particularly when comparing the average amount of opioids prescribed per person. For instance, in 1999 the average prescription was about 180 MME per person, compared to about 640 MME per person in 2015. The CDC offers some recommendations for providers to help lower opioid prescribing even further:

  • Use opioids only when benefits outweigh the risks, and when other pain medicines and management are ineffective
  • When writing a prescription for opioid medication, keep the period of time a patient is on the medication lower. For example, the CDC notes that prescriptions should only be for the expected duration of pain severe enough to need opioids; often, three days is the maximum amount of time they are needed.
  • Use the lowest effective dose of opioid medications

According to another CDC report, between July 2016 and September 2017, emergency department visits for suspected opioid overdoses increased by 29.7%. In sixteen states, all of whom have a high prevalence of overdose mortality, increases were as high as 34.5%. Every demographic group reported substantial rate increases, including gender groups (males 30% and females 24%) and all age groups (31% among 25–34 year olds, 36% among 35–54 year olds, and 32% among those 55 years of age and older). Ultimately, the highest opioid overdose rate increases occurred in large central metropolitan areas, which have a population of at least one million people and surround a principal city.

The CDC argues that data from hospital emergency departments can serve as an early warning system to alert communities of changes in opioid overdose trends. This is because of the rapid availability of this data, which is, in many cases, within 24–48 hours of an Emergency Room visit. Emergency Room treatment for a drug overdose also provides unique opportunities for intervention, though this intervention can require coordination among numerous health care providers, allied health professionals, and agencies. When addressing individual cases, and sharing or utilizing patient data, it is important to remain compliant with regulations protecting that data, such as HIPAA.

Information Sharing Can Play a Vital Role, but Don’t Forget HIPAA Compliance

Recently, the HHS Office for Civil Rights (OCR) issued new guidance on HIPAA, information sharing, and addressing the opioid crisis. This guidance sought to answer key questions, such as:

  • How can healthcare providers share health information with a patient’s family members, friends, and legal representation when the patient is incapacitated, such as during an opioid overdose?
  • How can providers ensure that families have the information they need to help their loved ones struggling with addiction?

The OCR made it clear that current HIPAA regulations allow providers to share specific types of healthcare information with a patient’s family in certain dangerous or emergency situations. This includes instances when there is an impending threat to a patient’s health or safety. In situations such as this, it might be permissible to share select information with people who are in a position to mitigate or prevent such an impending threat. It is also critical for healthcare providers to understand when it is appropriate to share information with patients’ family and friends, and how to share that information without violating the HIPAA Privacy Rule.

You can access more information from the OCR in their publication How HIPAA Allows Doctors to Respond to the Opioid Crisis.  One of the main points of this publication is that there are certain limitations on sharing patient health information with family and friends out of respect for the patient’s autonomy and decision-making capacity. There are exceptions, however, that take into account whether the patient is incapacitated or facing a serious and imminent threat to their health and safety.

HIPAA also anticipates that a patient’s decision-making capacity might change throughout the course of their treatment. Therefore, healthcare providers should be aware when their patient’s decision-making capacity changes, and offer them the opportunity to agree or object to the sharing of their information accordingly. Finally, it is important to note that HIPAA recognizes patients’ personal representatives (such as a parent or legal guardian or others who have been granted the authority to make healthcare decisions on behalf of the patient) in accordance with state law.

Make sure that you remain knowledgeable about how to review and monitor healthcare programs at your organization that may treat patients potentially suffering from opioid addiction with Healthcare Auditor Training. For example, the American Institute of Healthcare Compliance is offering a three-day classroom training opportunity in May 2018: the Auditing for Compliance Training Camp! At this training camp, we will cover key topics, such as monitoring systems and protocols for compliance, government compliance, and root cause analysis.


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